Adrenal Crisis

Question 1

symptoms

Answer 1

previous steroid therapy
headache, fever, confusion
nausea/vom
low blood pressure
high resp rate and pulse

Question 2

what do you do when a pt has adrenal crisis?

Answer 2

lay pt flat and lift legs
- call 999

• check for steroid emergency card
• administer pts hydrocortisone emergency injection if available

check capillary blood glucose
monitor

Question 3

what is adrenal crisis?

Answer 3

when there is insufficient cortisol available in response to stress

Question 4

what are the risk factors for adrenal crisis?

Answer 4

long term steroid therapy
pregnancy
GI illness
infection
injury
physiological stress/pain

Question 5

if a pt has already known adrenal insufficiency, how should they be treated prior to dental tx?

Answer 5

treat with additional steroid cover

restoration, hygiene, endodontic, extraction under local
- double the usual steroid dose
- give an hour prior to tx

if extraction under GA
- 100mg hydrocortisone IM injection
- just prior to the extraction

Question 6

what is the post-op advice

Answer 6

double daily steroid code for 24 hrs

Question 7

how do you know it isn’t hypoglycaemia

Answer 7

adrenal crisis
- prev. steroid therapy
- pt has Addisons disease
- abdo disease
- hypotension
- fever

hypoglycaemia
- aggression
- hunger
- tremor